Intravascular Ultrasound for Transjugular Intrahepatic Portosystemic Shunt Creation: "TIPS" and Tricks.

Abstract

Cirrhosis affects 4.5 million people in the United States.[1] Sequela of cirrhosis and portal hypertension include varices, which occur in up to 60 to 80% of cirrhotic patients and pose a bleeding risk of 25 to 35%[2]; refractory ascites, which occurs in 5 to 10% of patients[3]; recurrent hepatic hydrothorax, which occurs in 5 to 10% of cirrhotic patients[4]; and hepatic encephalopathy, which occurs in up to 45% of patients with cirrhosis.[5] Transjugular intrahepatic portosystemic shunt (TIPS) creation results in portal venous decompression and reduces mortality and morbidity associated with these portal hypertensive sequelae. There is a clear survival benefit with TIPS creation in patients at risk of variceal hemorrhage, including those who fail endoscopic banding, who are at high risk of pharmacologic or endoscopic treatment failure,[6] and who undergo early TIPS creation for secondary prophylaxis against bleeding.[7] [8] For those with refractory ascites and hepatic hydrothorax, resolution of fluid accumulation can be expected in 85%[9] and 82%, respectively.[10]